Pneumomediastinum following intubation in COVID-19 patients: a case series

Anaesthesia. 2020 Aug;75(8):1076-1081. doi: 10.1111/anae.15113. Epub 2020 Jun 11.


The number of patients requiring tracheal intubation rose dramatically in March and April 2020 with the COVID-19 outbreak. Our thoracic surgery department has seen an increased incidence of severe pneumomediastinum referred for surgical opinion in intubated patients with COVID-19 pneumonitis. Here we present a series of five patients with severe pneumomediastinum requiring decompression therapy over a 7-day period in the current COVID-19 outbreak. We hypothesise that the mechanism for this is the aggressive disease pathophysiology with an increased risk of alveolar damage and tracheobronchial injury, along with the use of larger-bore tracheal tubes and higher ventilation pressures. We present this case series in order to highlight the increased risk of this potentially life-threatening complication among the COVID-19 patient cohort and offer guidance for its management to critical care physicians.

Keywords: COVID-19; acute respiratory distress syndrome; pneumomediastinum; surgical emphysema; tracheal injury.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Betacoronavirus*
  • COVID-19
  • Coronavirus Infections / complications*
  • Coronavirus Infections / therapy
  • Fatal Outcome
  • Female
  • Humans
  • Intubation, Intratracheal / adverse effects*
  • Male
  • Mediastinal Emphysema / diagnostic imaging
  • Mediastinal Emphysema / etiology*
  • Mediastinal Emphysema / therapy
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / therapy
  • Prospective Studies
  • Radiography, Thoracic
  • Respiration, Artificial / methods
  • SARS-CoV-2
  • Tomography, X-Ray Computed
  • Trachea / injuries